MEDICARE: SAEID KHODABAKHSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	185991	NY

General Provider Information

NPI Number	:	1316994718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAEID KHODABAKHSH MD

Provider Business Mailing Address
First Line	:	2554 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4904
Country	:	US
Telephone Number	:	718-240-8600
Fax Number	:	718-240-8607

Provider Business Practice Location Address
First Line	:	2554 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4904
Country	:	US
Telephone Number	:	718-240-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	10/21/2013

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